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Orthotic and assistive devices help CP patients walk.
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Cerebral palsy is a nonprogressive neurological condition that affects children anytime before birth through the first five years of life. Although the symptoms do not worsen as someone ages, they continue to impact functional abilities throughout the individual's life. Muscle tightness is a main characteristic of cerebral palsy, reducing range of motion in arm and leg joints. Orthotic splints hold affected joints in a stretched position to counteract muscle tightness and improve mobility.
Spastic cerebral palsy is the most common form of the disease. According to the Centers for Disease Control and Prevention, spastic CP accounts for approximately 80 percent of cases. It is characterized by excessive tightness in muscles and reduced range of motion in affected joints. Spasticity commonly affects the calf muscles in the legs, causing the heel to lift up off the ground. Arm spasticity affects muscles that bend the fingers, wrist and elbow, drawing the arm in toward the body. Orthotics -- splints -- position the affected joints to improve mobility and function.
Cerebral palsy commonly affects the lower extremity, causing increased muscle tone in the gastrocnemius muscle located in the back of the lower leg. Tightness in this muscle pulls the foot into plantarflexion -- pointing the toes toward the floor and raising the heel up off the floor. Because the gastrocnemius muscle crosses the knee joint, tightness prevents the knee from straightening fully in a standing position. Ankle-foot orthoses, or AFOs, are worn to position the ankle in a neutral position -- bent at approximately 90 degrees -- to improve walking abilities.
AFOs are worn while the child is learning to stand, and use is continued throughout the individual's life. These splints are made by trained health-care professionals, and physical therapists work with children and their parents to teach the children how to use the orthotics. Gait training interventions are used to teach children how to walk with AFOs. New splints are made as the child grows into adulthood to ensure a proper fit.
Knee-ankle-foot orthoses (KAFOs) are sometimes used to stretch both the ankle and knee to address spasticity in the lower extremity. The bottom of the KAFO functions like an AFO, while the top of the brace holds the knee locked in a straight position. Static KAFOs hold the knee and ankle in a locked position, while dynamic KAFOs have a spring component that allows some movement of the ankle joint. Static KAFOs are worn at night and during rest periods during the day to stretch tight muscles. Dynamic KAFOs are sometimes worn while walking to improve the gait.
According to BMC Pediatrics, use of orthoses during rest periods to stretch muscles is not well supported by research. However, it continues to be a common practice and orthotic use is assumed to be effective for contracture prevention when worn for six or more hours each day.
Upper Extremity Orthoses
Hand orthoses decrease muscle tightness in the hand and improve functional grasp. Splints keep the wrist out of a bent position to allow a person to use his fingers to grasp objects. Severe spasticity draws the fingers and thumb tightly into the palm, and hand splints allow the hand to be cleaned and keep the fingernails from cutting into the skin. Elbow orthoses open the joint from a severely bent position, counteracting the tight muscles and supporting weak muscles.
Leg orthoses can be worn while a child is learning to stand. People with CP often wear AFOs throughout their life to improve walking. Leg orthoses are designed to be worn inside footwear, and failure to do this could result in falls. As a child grows, new orthoses must be fabricated to ensure proper fit. Redness, pain and skin breakdown are signs that hand or leg orthotics might be too small and should not be used. Over time, AFOs become worn. Consult a health-care professional once a year to assess the fit and condition of the splint.